title: Immobilization in internal or external rotation does not change recurrence rates after traumatic anterior shoulder dislocation.
abstract: BACKGROUND
  The objective of this study was to systematically review and quantitatively synthesize the data on recurrence rates after shoulder immobilization in internal versus external rotation in first-time, traumatic shoulder dislocations.
  
  
  METHODS
  We performed a systematic search of the keywords "(((external rotation) OR internal rotation) AND immobilization) AND shoulder" in the online databases PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Library. Random-effects models were used to calculate the cumulatively pooled risk ratios (RRs) of recurrent shoulder dislocations. All analyses were also stratified by age.
  
  
  RESULTS
  We included 5 studies with a total of 471 patients (230 internal rotation and 241 external rotation) published between 2001 and 2011 in English. The pooled random-effects RR for recurrence of shoulder dislocations at all ages was 0.74 (95% confidence interval [CI], 0.44-1.27; P = .278). The RR was 0.70 (95% CI, 0.38 to 1.29; P = .250) for patients aged 30 years or younger and 0.78 (95% CI, 0.32 to 1.88; P = .579) for those aged older than 30 years.
  
  
  CONCLUSIONS
  The current best evidence does not support a relative effectiveness of immobilization in external rotation compared with internal rotation to avoid recurrent shoulder dislocations in patients with traumatic anterior shoulder dislocations.
authors.affiliation: Orthopaedic Department, University Hospital of Basel, University of Basel, Basel, Switzerland; Division of Sports Medicine & Department of Orthopedic Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA; Center for Population and Development Studies, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Vavken
authors.affiliation: Department of Orthopedic Surgery, Medical University of Graz, Graz, Austria. Electronic address: patricksadoghi@gmx.at.
authors.forename: Patrick
authors.initials: P
authors.lastname: Sadoghi
authors.affiliation: Orthopaedic Department, University Hospital of Basel, University of Basel, Basel, Switzerland.
authors.forename: Julia
authors.initials: J
authors.lastname: Quidde
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Lucas
authors.affiliation: Harvard Combined Residency Program, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Ruth
authors.initials: R
authors.lastname: Delaney
authors.affiliation: Orthopaedic Department, University Hospital of Basel, University of Basel, Basel, Switzerland; Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Andreas M
authors.initials: AM
authors.lastname: Mueller
authors.affiliation: Orthopaedic Department, University Hospital of Basel, University of Basel, Basel, Switzerland; Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Claudio
authors.initials: C
authors.lastname: Rosso
authors.affiliation: Orthopaedic Department, University Hospital of Basel, University of Basel, Basel, Switzerland.
authors.forename: Victor
authors.initials: V
authors.lastname: Valderrabano
mesh_terms: D000328:Adult; D000465:Algorithms; D001915:Braces; D005260:Female; D006801:Humans; D007103:Immobilization / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D012008:Recurrence; D012399:Rotation; D012783:Shoulder Dislocation / Q000503:physiopathology / Q000628:therapy*; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000503:physiopathology
keywords: Immobilization; Level II; Meta-analysis; meta-analysis; recurrence rate; shoulder dislocation